Accepting what nurses cannot fix
Like perhaps many of you, I come from a long line of “fixers.” Multiple people whose schedules are conflicting? We'll coordinate. Someone isn't able to find a job? We'll provide help on their resume and introduce them around. A friend needs a boyfriend? Let me show you my multi-step PowerPoint plan.
This take-charge attitude is often helpful in a work environment, where a fixer can jump in to save a flailing project, mentor a new employee or get all entities in a room to hash out a problem. Nurses are often the ultimate “fixers” in that they not only can juggle multiple problems each day, but can be the best person to fight for a resident who needs a new medication, room or updated care plain.
Even though nurses know death is a part of the job, I suspect that's why this particular group may struggle when someone — be it a loved one, resident or patient — is dying. That's where a new book, “To Comfort Always: A Nurses' Guide to End-of-Life Care,” may be a helpful resource.
A section in the book on suffering, where author Linda Norlander addresses reservations about treating end-of-life patients, particularly struck me. One of the questions is, “What if the patient has a problem I can't fix?”
Norlander encourages the answer as: “Not all symptoms, suffering or distress at the end of life can be ‘fixed.' The message to convey to patient and families is this: ‘I will not abandon you and I will do everything in my power to make things more comfortable.'” That feels far more empowering than the dour, “There's nothing I can do.”
The chapter goes on to discuss being present with a dying person — listening, acknowledging and touching. There is a tricky balance between false encouragement to a resident or family, such as, “I'm sure you'll be better soon,” and allowing a terminally ill patient to talk about dreams. One hospice nurse comments, “I don't see anything wrong with [dying patients] talking about going to the white sand beaches of the Caribbean, even though I know they will probably never get there. To dream and to wish and to hope is human.”
There's also having to expand how caregivers fix issues such as pain and suffering. Certainly, there's valuable information in the book related to assessing physical pain. One hospice nurse notes that she visited a dying patient at home who was in terrible pain. But when asked what she wanted, she said the most important thing to her wasn't the pain: It was reconciling with her daughter. The nurse arranged for the daughter to come over with a social worker. This may not offered a magical “fix” to the estrangement, but addressed the most critical need for the patient.
This concept of being present, rather than focusing on fixing, carries on after death. One of the important aspects, Norlander writes, is to allow the family time to be with the body in order to say good-bye. Nurses, while they may be rushed, also can ask concrete questions such as, “Do you have someone I can call for you?” or “Can I get you a glass of water?” rather than the generic “Can I do anything for you?”
It's also important for both nurses and administrators to recognize compassion fatigue. Norlander suggests that workplaces create a culture of good team support and development, access to continuing education and built-in supports such as grief acknowledgement rituals. It's not uncommon for hospice programs to set aside time for staff to reflect on patients who have died, she says.
Do you struggle between the desire to fix and being present? What strategies have helped? Leave a comment below — I'll randomly choose a commenter to receive a courtesy copy of Norlander's book.
Elizabeth Newman is Senior Editor at McKnight's. Follow her @TigerELN.